Nakane Y, Akehira K, Okumura S, Okamura S, Boku T, Okusa T, Hioki K
Second Department of Surgery, Kansai Medical University, Osaka, Japan.
Surg Today. 1997;27(8):696-701. doi: 10.1007/BF02384979.
The authors modified the operative procedures used in pouch and interposition (PI) reconstruction in an attempt to improve the surgical results after total gastrectomy, because a randomized controlled trial had revealed that the clinical assessment of PI was quite poor, even though it is a physiological route. In most of the treated patients, the gastric emptying test revealed delayed emptying, and an X-ray video film showed folding and twisting of the jejunal conduit between the pouch and duodenum, which disturbed the transmission of nutrition. Modified PI (m-PI) was performed by decreasing the length of the jejunal conduit and widening the mesenteric pedicle to preserve the blood and nerve supply. This procedure was retrospectively compared with the previously used PI reconstruction by evaluating the postprandial symptoms, food intake, body weight, serum nutritional parameters, and emptying time of the gastric substitute. The m-PI group (n = 6) showed a lower incidence of symptoms, a greater food intake, and a greater weight recovery than the PI group (n = 6). The gastric emptying test also revealed an acceptable degree of emptying. We thus conclude that the m-PI reconstruction is more useful for improving the postoperative quality of life than the previously used method of PI reconstruction.
作者对用于袋状和间置（PI）重建的手术操作进行了改良，试图改善全胃切除术后的手术效果，因为一项随机对照试验显示，尽管PI是一种生理性路径，但对其临床评估相当差。在大多数接受治疗的患者中，胃排空试验显示排空延迟，X线录像显示袋状结构与十二指肠之间的空肠导管出现折叠和扭曲，这干扰了营养物质的传输。改良的PI（m-PI）通过缩短空肠导管长度并加宽肠系膜蒂以保留血供和神经供应来实施。通过评估餐后症状、食物摄入量、体重、血清营养参数以及胃替代物的排空时间，将该手术与先前使用的PI重建进行回顾性比较。m-PI组（n = 6）与PI组（n = 6）相比，症状发生率更低，食物摄入量更大，体重恢复更好。胃排空试验也显示出可接受的排空程度。因此，我们得出结论，与先前使用的PI重建方法相比，m-PI重建在改善术后生活质量方面更有用。
